A new nicotine product comes in the form of what is called an e-cigarette. It is a cigarette with the promise of the drug effects of nicotine without the tars that tobacco cigarettes give. Its cost is much less that traditional tobacco cigarettes An e-cigarette is a cartridge filled with a nicotine solution. There is a battery powering a coil. That then heats the solution into vapor. The vapor is sucked in and exhaled like smoke. It looks like a regular cigarette except the tip often glows blue instead of red. That is due to the LED light at the end of the tip. Statistics show that e-cigarettes are a bo oming business. In 2008 annual sales were $20 million. In 2009, they about doubled to $39 million. In 2010, they more than doubled to $82 million. In 2011, they more than doubled again to $195 million. In 2012, they more than doubled again to $500 million. In 2013, they more than doubled again to over $1 billion. If you do the math that is an increase of about 5000% in about 6 years. They used to be manufactured by non-traditional cigarette companies. However, tobacco companies are not dumb. As they see the sales take off, they are jumping on the bandwagon. They are now producing their own e-cigarettes. You can bet that heavy advertising will follow. In addition, one of the things that we know is that adolescents do not buy as many cigarettes when the price is high. That is why high cigarette taxes decrease adolescent users. A cheaper alternative might encourage more adolescents to become nicotine addicts. That would be a shame after the numbers have been consistently dropping over the years. However, one might ask what do we really know about e-cigarettes. The answer is clear. We know very little. We actually will not know a lot for a number of years. Think how many centuries it took before we realized the toxic effect of tobacco. Think how long it took us to realize the effects of second hand smoke. An e-cigarette is not controlled by the FDA. Therefore, it means every manufacturer has its own concoction. A recent study showed that the amount of nicotine in different brands varied by as much as 20%. Thus, you have no clue what you are getting in the way of nicotine. We do not know what the long term effects of inhaling this nicotine vapor will be. It might cause lung cancer. It might cause COPD (emphysema). The latter is more likely. It might cause mouth cancer. We do not know what the effects are of second hand inhalation of the vapor. Thus the move to try and use these in places that currently ban tobacco products could be harmful to other individuals. A recent study showed that the waste products accumulate on surfaces like walls and floors. This could cause third hand damage to people in the house who come in contact with the waste products. It also appears that the ones with heavier vapors go to the floors. The ones with lighter vapors go to the walls. It is interesting that this all began as a fad. It has become big business in a very short time. Therefore, the manufacturers are doing their best to push the product. We really need to have FDA regulation so there is consistency to the product. We need to continue to study the long term effects. What is very likely is that by the time we find out what the long term effects are, it will be too late for most users. Perhaps we can help prevent that by pointing out that the best way to use e-cigarettes is to avoid them in the first place.

If you have comments about this column or suggestions for other topics, send an email to Dr. Anthony Policastro at editor@mspublications.com

Non-compliant plans and the ACA The recent Obama administration decision to allow for the two-year extension of health plans that are not compliant with the Affordable Care Act (ACA) does not apply to the state of Delaware, as per state law. Delaware law, as currently written, does not allow for the extension of non-compliant health plans after Jan. 1, 2014. Furthermore, allowing the two-year extension of previously cancelled and non-compliant plans has the potential to raise premiums for everyone and could disrupt the market in Delaware, said Delaware Insurance Commissioner Karen Weldin Stewart.

House Bill 162 with House Amendment 1 was passed in 2013 by the 147th General Assembly to bring the Delaware code into compliance with the ACA. The law applies to all individual and group health insurance contracts, as applicable, issued or renewed on or after Jan. 1, 2014. Consumers that were affected by that agreement had until Dec. 31, 2013 to renew their policy. Consequently, any individuals that renewed their policy for one year by Dec. 31, 2013 will not be affected by this new announcement. Consumers who do not have health insurance coverage have until March 31, to sign up for a new plan. Individuals who do not have health insurance after this date may be subject to a tax by the IRS next year. Individuals with questions about subsidies and plans offered through the marketplace should visit www.choosehealthde.com or call 1-800-318-2596. For more information about health insurance, visit the Delaware Department of Insurance website at www.delawareinsurance.gov.

Nanticoke Health Treasure Hunt set for April 5 at Heritage Shores Residents of the community are invited to join a team of famous archaeologists on April 5, for The Jewel of the Nile, A Nanticoke Treasure Hunt to be held at The Pyramids at Heritage Shores in Bridgeville. The dinner and auction are sponsored by Nanticoke Health Services. As attendees walk through the secret doors inside the great Pyramids, they will become part of the archaeology team helping to locate the Nanticoke treasure. Guests will have the opportunity to bid on items in live and silent auctions. The evening will take them back to the Egyptian era of the 1930s. Proceeds will go toward the purchase of a fetal monitoring software system for Nanticokes Mother and Baby Care Center. The system, which will go live in April, will promote positive outcomes by providing a more complete picture of the mother and baby during labor and delivery and enhancing the coordination of care between physicians and nurses. Honorary chairs for the 2014 dinner and auction are doctors Eduardo L. Jiloca and Rosalina L. DeJesus-Jiloca. Businesses and individuals can support the event through sponsorships or by donating items for the auction. Sponsorship packages and additional information are available online at www.nanticoke.org/auction, by calling Nanticoke Health Services Foundation office at 536-5393, or by emailing FioriC@nanticoke.org. Tickets are $100 per person.

Enroll-a-Thon events offered The State of Delaware is hosting a series of Enroll-a-Thon events for Delawareans who are uninsured or underinsured so they can get help enrolling in a health insurance plan before the March 31 deadline. The following events will be held in Sussex County: Thursday, March 20, 5 to 8 p.m. - Richard A. Shields Elementary School, 910 Shields Ave., Lewes; Tuesday, March 25, 4 to 7 p.m. - Milton Elementary School, 512 Federal St., Milton; Thursday, March 27, 6 to 8 p.m. - Milford High School Room 411, 1019 N. Walnut St., Milford. If residents cannot attend the sessions, they can visit www.ChooseHealthDE.com to contact Marketplace Guide organizations to schedule an appointment, or call the 24/7 helpline with questions at 1-800-318-2596, TTY: 1-855-889-4325.

Sponsor sought for Walk for Autism A shortcut is now available for walkers who need a little help completing the 5K route of the Autism Delaware Walk for Autism in Lewes. More than 600 walkers are expected at the April 5 fundraiser in Cape Henlopen State Park. Title sponsorship of the 2014 Walk for Autism is available for any organization or company that would like to support people and families affected by autism. For more information, call Deanna Principe at 302-224-6020, ext. 213, or visit FioriC@nanticoke.org.